Concept: Hospital Types

Introduction

Hospitals in Manitoba range from small rural institutions having less than fifteen beds, to large urban teaching hospitals with hundreds of beds and a capacity to provide very specialized services. Use of one type of hospital instead of another has implications for the availability of specialized services, distance a patient must travel for care, and resource costs of providing care. Hospitals can be grouped according to similar characteristics such as location, size, function, level of specialization, and environment in order to permit analyses of the relative rates of use. The use of specific categories may vary depending on the purpose of a study. This concept identifies the different methods used in MCHP research to categorize hospitals.

MCHP Methods for Categorizing Hospitals

Over time, MCHP has used different methods to categorize hospital types during analyses. The method is dependent on the purpose and needs of an individual project. The following list identifies different MCHP research projects and the method used in each project to categorize hospitals.

1. Black et al. (1993)

In the deliverables Utilization of Hospital Resources. Volume I: Key Findings and Utilization of Hospital Resources. Volume II: Methods and Tables by Black et al. (1993), they developed seven categories to define hospital type:


1. Teaching - St. Boniface Hospital and Health Sciences Centre.
   
2. Urban Community - Five Winnipeg community hospitals and Brandon General Hospital.
   
3. Major Rural - Ten hospitals in major rural centres.
   
4. Intermediate Rural - Ten intermediate hospitals in rural areas.
   
5. Small Rural - 37 small hospitals in rural areas.
   
6. Small Multi-use - Six small hospitals that have, in addition to regular hospital beds, swing beds that can provide either hospital or PCH services.
   
7. Northern Isolated Hospitals - Five isolated hospitals in northern Manitoba.

For a complete list of hospitals included in each category, please see Appendix A - Hospitals Classified By Level of Care.

Additional categories were developed for other types of facilities and institutions, including:


• personal care homes (PCH)/nursing homes,
  
• chronic and rehabilitation institutions,
  
• federal nursing stations, and
  
• out-of-province facilities.

Hospital Type SAS® format and SAS label files - 1992 related to this research are available below. The format identifies the type of hospital / facility based on hospital identification number and the label file provides a description of the hospital type. The 11 categories identified above were developed with input from the Capital Planning of Manitoba Health Information System. The format was based on the rated beds in 1991/92 as outlined in the MHSC Annual Statistics 1991/92. These counts excluded the Extended Treatment beds in acute care hospitals.

The following MCHP research projects/publications used the same method described above for categorizing hospitals:


• Hospital Case Mix Costing Project 1991/92. by Shanahan et al. (1994),
  
• Hospital Case Mix Costing Project 1991/92: Methodological Appendix. by Lloyd et al. (1995), and
  
• Using the Manitoba Hospital Management Information System: Comparing Average Cost Per Weighted Case and Financial Ratios of Manitoba Hospitals. The Next Step. by Finlayson et al. (2001).

2. Black et al. (1994)

In the deliverable Redirecting Care from Winnipeg Hospitals to Ten Large Rural Facilities: Estimated Number of Cases, Feasibility and Implications by Black et al. (1994), they were asked to investigate the feasibility and impact of redirecting services from Winnipeg hospitals to large rural facilities (target hospitals). For this study they developed three categories of hospitals:


1. Target - refers to the hospitals of primary focus where service areas were defined. The ten target hospitals for which analyses were conducted included: Brandon, Dauphin, Flin Flon, Morden-Winkler, The Pas, Portage, Selkirk, Steinbach, Swan River and Thompson hospitals;
   
2. Winnipeg - refers to Winnipeg acute hospitals, including Concordia, Grace, Health Sciences Centre, Misericordia, St. Boniface, Seven Oaks and Victoria hospitals. These hospitals were further subdivided into two categories: teaching (Health Sciences Centre and St. Boniface) and community (all others) hospitals. Riverview and Deer Lodge were excluded from this category; and
   
3. Other - refers to all other hospitals in the province, other than the target hospitals and Winnipeg hospitals identified above.

3. De Coster et al. (1996)

In the deliverable Alternatives to Acute Care by De Coster et al. (1996), they classified hospitals into four categories, combining some of the categories developed by Black et al. (1993) described above. The four categories of hospital type used in this research included:


• urban (teaching and urban community),
  
• major rural,
  
• intermediate rural, and
  
• small rural (small rural and small multi-use).

NOTE: Northern Isolated hospitals were not part of the review completed in this project.

4. Stewart et al. (2000)

In the deliverable Assessing the Performance of Rural and Northern Hospitals in Manitoba: A First Look by Stewart et al. (2000), they used five different hospital categories to assess the performance of rural and northern hospitals in Manitoba. These five categories included:


• major rural;
  
• intermediate rural;
  
• small rural;
  
• small multi-use; and
  
• Northern Isolated hospitals

Several population- and hospital-based indicators were developed: need for hospital care, use relative to need, hospital share of area, admissions, intensity of cases treated, discharge efficiency and occupancy rate. Scores for each hospital were derived from these measures and are available as an Excel spreadsheet: MCHP Documentation - Assessing the Performance of Rural and Northern Hospitals - Hospital Scores Ordered by RHA. For an explanation of the indicators, see Section 2.1 - Population Based Indicators in the deliverable.

5. Menec et al. (2004)

In the deliverable Patterns of Health Care Use and Cost at the End of Life by Menec et al. (2004), they classified hospitals into three categories:


• teaching (St. Boniface General Hospital and Health Sciences Centre);
  
• urban community (Brandon and five hospitals in Winnipeg: Concordia, Grace, Misericordia, Seven Oaks and Victoria); and
  
• rural (all other hospitals in the province not listed above).

6. Fransoo et al. (2013)

In the deliverable Who is in our Hospitals ... and Why? by Fransoo et al. (2013), Manitoba acute care hospitals were classified into six different types based on volume and complexity of cases and hospital bed count. The categories, including the total number of hospitals in a category (in brackets), included:


• tertiary (2),
  
• Urban Community (6),
  
• Major Rural (9),
  
• Intermediate Rural (15),
  
• Small Rural (26), and
  
• transitional care facilities (13).

For a complete list of hospitals in each category, please see the Hospital Type glossary term in the 2013 deliverable. For a list of hospitals by Health region, including facility number, hospital name, hospital type and number of setup beds, please see Table 1.1: Facility Information for Hospitals in Manitoba, 2009/10-2010/11 in the 2013 deliverable.

Additional categories were developed to identify other types of Manitoba facilities / institutions that do not provide acute care, or provided care in out-of-province facilities, including:


• nursing stations,
  
• chronic and rehabilitation facilities,
  
• personal care homes (PCH),
  
• other clinics / health centres,
  
• a subset of Health Sciences Centre (HSC) - used with Medical Services (Physician Claims) data only,
  
• out-of-province facilities,
  
• unknown / not otherwise specified (NOS),
  
• missing, and
  
• other.

Hospital Type SAS® format and SAS label files - 2012 related to this research are available below. The format identifies the type of hospital / facility based on hospital identification number and the label file provides a description of the hospital type.

Cautions and Limitations

• Long Term Care hospitals such as Deer Lodge and Riverview should be referred to as 'Long Term Care facilities' and should include a note (as a footnote or in the text) that they provide assessment and treatment, rehabilitation, chronic and personal care.
  
• In Fransoo et al. (2013) they included the "federal" hospital in Hodgson, but not the one in Norway House because it was not providing inpatient services during the study period. Nursing stations, mental health facilities (Selkirk and Eden), and chronic care facilities (e.g., Riverview, Deer Lodge) were excluded.
  
• In Fransoo et al. (2013), the Misericordia Health Centre was included in the list of Urban Community hospitals in Winnipeg for completeness. Even though it is no longer an acute care facility, a small number of cases were admitted for short stays after receiving eye care in the Ophthalmological Centre of Excellence.
  
  
• The list of hospitals included in each category has changed between 1992 and 2012. Please consult the lists of hospitals in each category in the SAS® formats to determine the hospitals included in each category during the specified time frame.